Autologous implantation of bilayered tissue-engineered respiratory epithelium for tracheal mucosal regenesis in a sheep model

The objective of this study was to regenerate the tracheal epithelium using autologous nasal respiratory epithelial cells in a sheep model. Respiratory epithelium and fibroblast cells were harvested from nasal turbinates and cultured for 1 week. After confluence, respiratory epithelium and fibroblast cells were suspended in autologous fibrin polymerized separately to form a tissue-engineered respiratory epithelial construct (TEREC). A 3 × 2 cm² tracheal mucosal defect was created, and implanted with TEREC and titanium mesh as a temporary scaffold. The control groups were divided into 2 groups: polymerized autologous fibrin devoid of cells (group 1), and no construct implanted (group 2). All sheep were euthanized at 4 weeks of implantation. Gross observation of the trachea showed minimal luminal stenosis formation in the experimental group compared to the control groups. Macroscopic evaluation revealed significant mucosal fibrosis in control group 1 (71.8%) as compared to the experimental group (7%). Hematoxylin and eosin staining revealed the presence of minimal overgrowth of fibrous connective tissue covered by respiratory epithelium. A positive red fluorescence staining of PKH26 on engineered tissue 4 weeks after implantation confirmed the presence of cultured nasal respiratory epithelial cells intercalated with native tracheal epithelial cells. Scanning electron microscopy showed the presence of short microvilli representing immature cilia on the surface of the epithelium. Our study showed that TEREC was a good replacement for a tracheal mucosal defect and was able to promote natural regenesis of the tracheal epithelium with minimal fibrosis. This study highlighted a new technique in the treatment of tracheal stenosis.

A scanning electron microscopic study of in vivo tissue engineered respiratory epithelium in sheep

Normal tracheal mucociliary clearance is the key to maintaining the health and defense of respiratory airway. Therefore the present of cilia and mucous blanket are important for tracheal epithelium to function effectively. In the present study, we prepared a tissue engineered respiratory epithelium construct (TEREC) made of autologous respiratory epithelium cells, fibroblast and fibrin from sheep owns blood which replaced a created tracheal mucosal defect. Scanning electron microscopy (SEM) showed encouraging result where immature cilia were present on the surface of TEREC. This result indicates that engineered respiratory epithelium was able to function as normal tissue.

Parapharyngeal abscess complicated by endophthalmitis: a rare presentation of nasopharyngeal carcinoma

Objective:

We report an extremely rare case of nasopharyngeal carcinoma presenting as a lateral neck abscess complicated by endogenous bacterial endophthalmitis. Endogenous bacterial endophthalmitis complicating a neck abscess has not been reported in the recent English literature. We discuss the possible pathophysiology of neck abscess as a presenting feature of nasopharyngeal carcinoma, and the relationship between the parapharyngeal abscess and endogenous bacterial endophthalmitis.

Case report:

A middle-aged Chinese man presented with a left neck abscess associated with progressive vision deterioration and proptosis of the left eye. Incidentally, his random blood glucose was found to be elevated. Nasal endoscopy also revealed bilateral bogginess in the fossa of Rosenmuller. A diagnosis of left neck abscess with endogenous endophthalmitis associated with underlying diabetes mellitus was made. A computed tomography scan of the neck showed a left parapharyngeal abscess. Incision and drainage of the abscess together with biopsy of the nasopharynx was performed. Due to the non-salvageable condition of the left eye, evisceration was also performed. Pus culture studies from the neck abscess grew Klebsiella pneumoniae, and nasopharyngeal biopsy revealed undifferentiated carcinoma.

Conclusion:

Nasopharyngeal carcinoma is endemic in South East Asia and can have multiple, varied presentations. Therefore, in this setting, the clinician should have a high index of suspicion, especially in a patient from the Chinese ethnic group.

Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

Rhino-orbito-cerebral mucormycosis: a treatment dilemma

A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. Amphotericin B and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.

Hashimoto's thyroiditis: a rare cause for rhinosinusitis

Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice allergy seems to be a predominant cause followed by other less common causes like infection, drugs and aspirin hypersensitivity. We present a case of chronic rhinosinusitis secondary to hypothyroidism. Although hormonal causes like hypothyroidism have been proven to cause nasal congestion and rhinosinusitis, this is the first reported case of chronic rhinosinusitis in Hashimoto's thyroiditis in our center. This is a diagnosis of exclusion for chronic rhinosinusitis not responding to optimal medical therapy.

Knee crepitus from an unusual source

A case report of a missed appendicitis presenting with abdominal wall necrotising fasciitis which extended up to the right knee. This subcutaneous collection in the prepatella region of the right knee presented as a crepitus and mimicked an intraarticular pathology.